About

The Building State Capability (BSC) program at Harvard’s Center for International Development uses the Problem Driven Iterative Adaptation (PDIA) approach to build the capability of organizations to execute and implement.

This is a team of physicians working as District Blood Transfusion Officers for Tamil Nadu AIDS Control Society (TANSACS) living in India. They successfully completed the 15-week Practice of PDIA online course that ended in December 2018. This is their story.

We enrolled into the PDIA course without knowing what it was and what we needed to do. But the Project Director of TANSACS encouraged us, gave us objectives that we were struggling with and directed us to engage with this new tool/approach. So one fine day, we joined the ride on “Practice of PDIA 2018F” with our objective to solve – How do we address the problems faced by Government blood banks, in acquiring 20% of blood units collected by private blood banks in Tamil Nadu, India.

Government blood banks in Tamil Nadu are facing a shortage of blood units and acquiring 20% of blood units from private blood banks was a strategy to increase the blood stocks. But private blood banks were not willing to part with blood units as it was money for them. They either did not report their blood donation camps or under-reported their collection in camps. Either way, the Government blood banks were suffering from increasing demand and a reducing donor pool.

We started with a 6 member team and early on, we learnt about the big stuck faced by countries aiming for development. The book “Building State Capability” became the bible for the next 15 weeks. We learned new terms like Implementation gap, Isomorphic Mimicry, Premature load bearing and Transplantation. Some of our team members could not spare the time and energy needed for PDIA and bowed out. And this was the ‘first lesson learnt’ for us and we rallied and reinforced ourselves that we will fight to the finish, like plotting the map of 1804!

We found that the problem we were facing belonged to the typology ‘Implementation intensive service delivery’ which was not wicked hard category. We came to know that success of a leadership is not for the face of the leader but through multi-agent leadership. We formed the team norms and started our group activity of engaging our problem. As we constructed and deconstructed our problem and formed our first fishbone diagram, we found that there were many sub-causes that led to our problem.

As we analyzed our change space, we discovered that the problem that we took to solve was just a sub-cause of a main problem that is, insufficient blood collection and inappropriate blood usage which is leading to deficit in blood units. If we try to address these causes, we wouldn’t even need the 20% of blood units from private blood banks. This was a revelation and we started to find suitable entry points and authorizing environment. The updated fishbone diagram is an example for the work that we put in and how we improved our perspective of the chosen problem.

We also came to know about the various stages of team formation and found that the storms we faced, were a norm in team formation. We identified roles for individual members of our team which was successful not only in completing weekly assignments, but also in engaging the authority during our iterations. We identified simple tasks that we can complete during the two iterations. We started with formation of Hospital Transfusion Committee at one of our team member’s Medical College, Gap analysis between blood collection and blood utilization and finding out restrictive transfusion thresholds that can be implemented in Indian setup. As the PDIA team pointed out, the initial iterations should be small and doable, so when we completed it, we were exhilarated.

We are still a long way from addressing the problem of increasing blood collection and educating against inappropriate blood usage, but this small step empowers us to carry on and do something for the anemic patients and accident victims attending Government hospitals. As the PDIA team taught us, ‘lessons learnt’ and ‘relationships built’ are also examples of progress. We strive to build relations with authorities and will disseminate the knowledge that we gained from this course.

PDIA really opened multiple thinking ways new possibilities for finding and fitting solutions that are based on specific contexts and current realities, by working with the policy makers.

Whether the problem is simple or complex, there are solutions to act upon. Most importantly, the interactions with the peers and this maiden entry for us to the PDIA Community of Practice will really have a bright future. The PDIA course learning is the highlight of this year-2018 for us. The course has given us the knowledge of a practical advice on how to proceed through an iterative learning process. The above mentioned learning process is really a tool for success.